Edinburgh Napier University

  Currently, human bone is a commonly used material to help promote fusion of the
vertebrae. The bone can be the recipient’s own bone (autograft) or allograft bone, where bone
is donated from another individual [1]. The use of or human tissue or a combination of human
tissue and synthetic bone graft material (allograft) to correct spinal deformities is becoming
more common [2]. The use of an allograft composed of human tissue, eliminates the need to
harvest the recipient’s own bone from elsewhere in their body, which is often not possible and
has associated complications [3] Delong et al., [4] describe the different types of bone graft
materials available as; dematerialised bone matrix, bone morphogenic proteins and bone graft
substitutes which can be subdivided into processed allografts or fresh frozen allografts. In
commenting on these materials they identify the major risk of disease transmission when
fresh frozen allografts are used [4]. Similarly, Conrad et al., [5] reports the risk of hepatitis C
transmission as a result of the use of allografts, highlighting that the transmission of bacterial
and viral infection is a significant risk of allograft procedures.
A fundamental tenet underpinning the treatment of patients using allograft is the
informed consent process applied to the treatment of the patient offered by the healthcare
professional. Informed consent allows people to protect themselves and take responsibility for
shaping their lives as they see fit [8]. A World Health Organisation International Working
Group [6] (Appendix I) in reviewing the application of the guiding principles on Human
Organ Transplantation, reiterated the primacy of informed consent for the removal and use of
human organs, tissues and cells, calling for the development of common, medical, scientific,
legal and ethical requirements on a global basis [7]. Informed consent allows people to
protect themselves and take responsibility for shaping their lives as they see fit. [8]. The
ethical principles of self-determination and the requirement for autonomous decision making
in consent to treatment which include the receipt of any organ, tissues or cells, has to
underpin the use of an allograft in all patient care. Self determination must include
information on any risks posed by treatment to allow the individual to weigh up these risks
and make an informed choice whether to accept or decline the treatment offered.